The prevalence of disruptive behavior in children born preterm is substantially higher than children born full-term. Early intervention for disruptive behavior in young preterm children is critical due to the stability of these behaviors and poor prognosis without treatment. Although treatment has been shown to be effective with this population, research examining parent-training interventions that specifically target disruptive behavior has been limited. Parent-Child Interaction Therapy (PCIT) is an evidence-based parent-training program for preschool-age children with disruptive behavior that has not been examined in children born preterm. The first long-term objective of this study is to extend the research base of PCIT to preterm children, an at-risk population in need of behavioral intervention. The second long-term goal of this study is to explore the potential role of physiology as a mediator of treatment outcome. The specific aims of the study are to evaluate the efficacy of PCIT with families of children born premature who present with elevated levels of parent-reported disruptive behavior by comparing a PCIT Immediate Treatment (IT) group with a Waitlist (WL) control group. It is hypothesized that in comparison to families in the WL group, the IT group will show after treatment: (a) fewer child disruptive behaviors as rated by parents; (b) improved scores on parent report measures of parenting stress and parenting practices; (c) greater child compliance during observed parent-child interactions; and (d) more positive and effective parenting behaviors during parent- child interactions. Additionally, it is hypothesized that changes in cardiac vagal tone, a measure of heart rate variability, will differentiate children in the IT and WL groups. Relevance to Public Health: According to the Institute of Medicine's report on preterm birth, the prevalence rate of preterm birth in the United States has increased considerably in the last decade to 12.5 percent of all births and currently constitutes a significant public health concern. Infants born preterm are at an increased risk for a variety of psychosocial problems in early childhood and show higher rates of disruptive behavior disorders. Research examining evidence-based treatments with these children is critical in preventing further and more serious problems in life. [unreadable] [unreadable] [unreadable]